International Urology and Nephrology 34: 237–240, 2002. © 2003 Kluwer Academic Publishers. Printed in the Netherlands. 237 Management of post-traumatic arterial priapism in children: Presentation of a case and review of the literature Levent Emir 1 , Serdar Tekgül 2 , Ayhan Karabulut 1 , Kemal Oskay 1 & Demokan Erol 1 1 Clinic of Urology, Ankara Teaching and Research Hospital, Ministry of Health; 2 Department of Urology, Hacettepe University, Ankara, Turkey Abstract. In this article, a 9-year-old boy with arterial priapism is presented. The patient was managed with the conservative measures including imipramine hydrochloride and a favorable outcome was achieved after 2 months of follow-up. The pathophysiology, diagnostic tools and treatment alternatives are discussed. Key words: Arterial priapism, Child, Trauma Introduction Priapism in childhood frequently reminds a veno- occlusive state due to sickle cell anemia. High-flow priapism due to unregulated afflux of blood in the sinusoids of the corpus cavernosum as a result of lace- ration of the cavernosal artery is very rarely reported. Although the diagnosis can be established easily with the typical clinical features even without the aid of radiological examinations, there is no consensus on the optimal treatment of arterial priapism. In this article, treatment alternatives are discussed through the accumulated 19 cases in the literature. Case report M.G., a 9-year-old boy, sustained a straddle injury to the perineum after being thrown from a bicycle on to the handlebar. A sustained painless erection developed while the patient was playing outdoors 7 days after the injury. The patient was brought to the hospital a day after no evidence of detumescence. On examination, a minor resolving ecchymosis was detected on the right hemiscrotum. A persistent erection of approxi- mately 50% to 75% complete rigidity was observed (Figure 1). Tension of the corpora cavernosa was found to be less in the anterior third of the penis and did not affect the glans. It was not painful. Diagnostic aspiration of the corpus cavernosum yielded bright red, obviously arterial blood with high oxygen satu- ration. The penis was wrapped with the Coban (3M) bandage. This did not produce even a transient relief of erection. The history of trauma, typical appearance of the penis and the painlessness of the erection led us to the diagnosis of ‘arterial’ priapism. Doppler sono- graphy was done twice with two different radiologists. Since the later sonographic examination localized an arteriocorporeal fistula, the patient was hospita- lized to perform angiography and embolisation of the fistula. During the hospital stay, ice packs were applied locally to the erect penis. One day after, penis was observed to be less turgid and the Doppler US scan revealed ceasing of the flow through the fistula.Therefore, it was decided to follow and treat the patient conservatively. The patient was also put on treatment with imipramine hydrochloride 1 mg/kg t.i.d. Detumescence of the penis was accelerated with in two weeks after this treatment and completely became normal after 2 months. Discussion Priapsim had been traditionally separated into two types as primary and secondary, until the introduc- tion of a new classification by Witt and colleagues in 1990 [18]. They classified priapism in two categories; veno-occlusive (low-flow) and arterial (high-flow). In low-flow priapism, blood gases in the corpus cavernosum shift from arterial level to the poorly oxygenated level after 6 hours. High-flow priapism